INTERNAL POSTING ONLY Medicaid Waiver Case Manager - Initial Assessments

South Alabama Regional Planning Commission • Mobile, AL

2d • $21 - $27 • Onsite

About The Position

The Case Manager - Initial Assessments is responsible for the implementation of the Medicaid Waiver Home and Community-based Services Program within the SARPC area, adhering to specific requirements outlined in the Medicaid Waiver guidelines. This role involves conducting assessments for new clients, performing yearly redeterminations for existing clients, making home visits to monitor services provided by contractors, identifying additional client needs, verifying monthly contractor billings, and completing daily service logs. The position receives general supervision from the Medicaid Waiver Team Lead, with objectives and work plans developed collaboratively. The employee is responsible for planning and executing assignments, with work reviewed from an overall perspective.

Requirements

• Bachelor’s Degree from an accredited four-year college or university in Social Work, Behavioral Sciences, Psychology, Geriatric Studies, or a related field.
• A minimum of one (1) year of work experience in home health or Aging programs.
• Completion of initial case manager’s training within three (3) months of employment.
• Completion of service coordination core training within one (1) month after initial training is received.
• A valid driver’s license and a good driving record.

Nice To Haves

• Knowledge of social work programs and processes preferred.
• Knowledge of community resources and support network available to clientele served.
• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA).
• Excellent communication skills, both orally and written.
• Ability to relate to the elderly and their unique problems.
• Knowledge and ability to operate office equipment including telephone, copy machine, fax machine, computer, and calculator.
• Knowledge and ability to do basic arithmetic.
• Ability to read and interpret guidelines and regulations and apply them to the job.

Responsibilities

• Establishes referral sources by disseminating information to organizations, agencies, and individuals. Receives and responds to verbal and written referrals of eligible Medicaid recipients to obtain information on potential clients and provide information to referral sources. Screens referrals for eligibility based on E&D Waiver requirements (medical and financial). Performs outreach in the community to grow the E&D Waiver Program.
• Conducts and prepares on-site assessments for potential clients to enroll them in the Medicaid Waiver Program. Explains the benefits and limitations of the Medicaid E&D Program to prospective clients. Submits completed forms to the appropriate state agency and follows up on their status to fill allocated slots in a timely manner. Serves as the point of contact for applicants before their application is approved or denied.
• Identifies and communicates as early as possible when an applicant’s needs are likely to exceed the services SARPC’s program can safely provide, and makes necessary referrals to other agencies.
• Communicates with physicians, physician’s offices, DSPs, and other personnel to execute all assessments in a timely manner.
• Authorizes contractors to initiate services after receiving notification of approval from Alabama Medicaid Agency, completing assessment forms and forwarding appropriate copies of assessments, care plans, and service authorization forms to the respective contractors. Visits contractors’ offices and exchanges information with appropriate personnel to ensure contractors are operating as outlined in guidelines.
• Briefs a designated Case Manager (assigned by the Case Manager Team Lead based on caseload and area served) after an assessment is approved, aiming for a seamless transition and rapid provision of services.
• Develops, monitors, and revises clients’ Care Plans in coordination with the client/caregiver to meet client needs and remain sensitive to the monthly statewide fiscal target. Conducts visits to clients’ homes to evaluate services provided by the Medicaid Waiver Program, ensuring appropriateness, adequacy, and acceptable quality. Prepares case notes of visits and evaluations for documentation in case files.
• Checks monthly billings submitted by contractors for services rendered to clients to ensure accuracy and conformity with clients’ Care Plans. Monitors the cost-effectiveness of Waiver services for each client.
• Conducts annual redetermination assessments on clients as outlined in Medicaid Waiver guidelines and completes HCBS forms to meet requirements prescribed by the Alabama Medicaid Agency.
• Places all documents as prescribed by SARPC and the Alabama Medicaid Agency in appropriate folders to maintain a permanent case record for each approved client.
• Composes and maintains reports such as HCBS Program Case Management Activity Record, Case Managers Daily Time Logs, and Respite Hour Logs as necessary.
• Meets regularly with the Case Manager Team Lead to provide updates on all current pending applications.
• Exchanges information with Medicaid Waiver clerical staff through written and verbal communication to assign work and follow up on tasks.
• Performs administrative functions as directed by the Medicaid Waiver Program Manager.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level